Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset-Reference-Cited by-同舟云学术

Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset

Published:2020-07 Issue:7 Volume:51 Page:2051-2057
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Casetta Ilaria¹^ORCID,Fainardi Enrico²,Saia Valentina³,Pracucci Giovanni⁴,Padroni Marina¹,Renieri Leonardo⁵,Nencini Patrizia⁴,Inzitari Domenico⁴,Morosetti Daniele⁶,Sallustio Fabrizio⁷,Vallone Stefano⁸,Bigliardi Guido⁹,Zini Andrea¹⁰,Longo Marcello¹¹,Francalanza Isabella¹²,Bracco Sandra¹³,Vallone Ignazio M.¹³,Tassi Rossana¹⁴,Bergui Mauro¹⁵,Naldi Andrea¹⁶,Saletti Andrea¹⁷,De Vito Alessandro¹⁸,Gasparotti Roberto¹⁹,Magoni Mauro,Castellan Lucio²⁰,Serrati Carlo²¹,Menozzi Roberto²²,Scoditti Umberto²³,Causin Francesco²⁴,Pieroni Alessio²⁵,Puglielli Edoardo²⁶,Casalena Alfonsina²⁷,Sanna Antioco²⁸,Ruggiero Maria²⁸,Cordici Francesco²⁹,Di Maggio Luca³⁰,Duc Enrica³¹,Cosottini Mirco³²,Giannini Nicola³³,Sanfilippo Giuseppina³⁴,Zappoli Federico³⁴,Cavallini Anna,Cavasin Nicola³⁵,Critelli Adriana³⁶,Ciceri Elisa³⁷,Plebani Mauro³⁷,Cappellari Manuel³⁸,Chiumarulo Luigi³⁹,Petruzzellis Marco⁴⁰,Terrana Alberto⁴¹,Cariddi Lucia Princiotta⁴²,Burdi Nicola⁴³,Tinelli Angelica⁴⁴,Auteri William⁴⁵,Silvagni Umberto⁴⁵,Biraschi Francesco⁴⁶,Nicolini Ettore⁴⁷,Padolecchia Riccardo⁴⁸,Tassinari Tiziana⁴⁹,Filauri Pietro⁵⁰,Sacco Simona⁵¹,Pavia Marco⁵²,Invernizzi Paolo⁵³,Nuzzi Nunzio P.⁵⁴,Marcheselli Simona⁵⁵,Amistà Pietro⁵⁶,Russo Monia⁵⁷,Gallesio Ivan⁵⁸,Craparo Giuseppe⁵⁹,Mannino Marina⁶⁰,Mangiafico Salvatore⁵,Toni Danilo⁴⁷,

Affiliation:

1. Clinica Neurologica, University of Ferrara, (I.C., M.P.).

2. Neuroradiology Unit, University of Florence (E.F.).

3. Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S.).

4. Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.).

5. Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.).

6. Diagnostic Imaging and Interventional Radiology Unit (D.M.), University of Rome Tor Vergata.

7. Stroke Unit (F.S.), University of Rome Tor Vergata.

8. Interventional Neuroradiology Unit (S.V.), Ospedale Civile “S.Agostino-Estense”, AOU Modena.

9. Stroke Unit (G.B.), Ospedale Civile “S.Agostino-Estense”, AOU Modena.

10. Neurology and Stroke Unit, Maggiore Hospital, Bologna (A.Z.).

11. Interventional Neuroradiology Unit, Policlinico G Martino, Messina (M.L.).

12. Stroke Unit, Policlinico G. Martino, Messina (F.I.).

13. Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.).

14. Stroke Unit, University Hospital “S. Maria delle Scotte”, Siena (R.T.).

15. Interventional Neuroradiology Unit, Città della Salute e della Scienza—Molinette, Turin (M.B.).

16. Department of Neuroscience “Rita Levi Montalcini”, University of Turin (A.N.).

17. Interventional Neuroradiology Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.S.).

18. Stroke Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.D.V.).

19. Interventional Neuroradiology Unit, “Spedali Civili”, Brescia (R.G.).

20. Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova (L.C.).

21. Neurology and Stroke Unit, IRCCS San Martino-IST, Genova (C.S.).

22. Interventional Neuroradiology Unit (R.M.), University Hospital, Parma.

23. Stroke Unit (U.S.), University Hospital, Parma.

24. Neuroradiology Unit (F.C.), Padua University Hospital.

25. Stroke Unit and Neurosonology Lab (A.P.), Padua University Hospital.

26. Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile “Mazzini”, Teramo.

27. Neurology Unit (A.C.), Ospedale Civile “Mazzini”, Teramo.

28. Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena.

29. Neurology Unit (F.C.). “M. Bufalini” Hospital-AUSL Romagna, Cesena.

30. Interventional Radiology and Neuroradiology Unit (L.D.M), San Giovanni Bosco Hospital, Torino.

31. Neurology Unit (E.D.), San Giovanni Bosco Hospital, Torino.

32. Neuroradiology Unit (M.C.), AOU Pisa.

33. Neurology Unit (G.N.), AOU Pisa.

34. Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.).

35. Neuroradiology Unit (N.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre.

36. Neurology Unit (A.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre.

37. Neuroradiology Unit (E.C., M.P.), AOUI Verona.

38. Neurology Unit (M.C.), AOUI Verona.

39. Interventional Neuroradiology Unit (L.C.), Policlinico Bari.

40. Stroke Unit (M.P.), Policlinico Bari.

41. Neuroradiology Unit (A.T.), AOU Circolo, ASST-Settelaghi, Varese.

42. Neurology and Stroke Unit (L.P.C.), AOU Circolo, ASST-Settelaghi, Varese.

43. Interventional Radiology (N.B.), Ospedale SS. Annunziata, Taranto.

44. Stroke Unit (A.T.), Ospedale SS. Annunziata, Taranto.

45. Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.).

46. Interventional Neuroradiology Unit, Policlinico Umberto I, Rome (F.B.).

47. Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.).

48. Neuroradiology Unit (R.P.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure.

49. Neurology and Stroke Unit (T.T.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure.

50. Interventional Neuroradiology Unit, PO SS. Filippo e Nicola, Avezzano (P.F.).

51. Department of Applied Clinical Sciences e Biotechnology, University of L’Aquila, L’Aquila (S.S.).

52. Neuroradiology Unit (M.P.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia.

53. Neurology Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia.

54. Interventional Neuroradiology Unit (N.P.N.), Humanitas Research Hospital, Rozzano.

55. Urgent Neurology and Stroke Unit (S.M.), Humanitas Research Hospital, Rozzano.

56. Interventional Neuroradiology Unit (P.A.), S. Maria della Misericordia Hospital, Rovigo.

57. Stroke Unit (M.R.), S. Maria della Misericordia Hospital, Rovigo.

58. Neuroradiology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria (I.G.).

59. Interventional Neuroradiology Unit (G.C.), Ospedale Civico-A.R.N.A.S., Palermo.

60. Stroke Unit (M.M.), Ospedale Civico-A.R.N.A.S., Palermo.

Abstract

Background and Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. Results: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). Conclusions: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Reference36 articles.

1. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

2. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

3. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

4. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

5. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke

Cited by 45 articles. 订阅此论文施引文献订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献

1. Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties;European Journal of Radiology Open;2023-12

2. Novel Programmed Death Ligand 1-AKT-engineered Mesenchymal Stem Cells Promote Neuroplasticity to Target Stroke Therapy;Molecular Neurobiology;2023-11-29

3. Prominent Vessel Signs After Endovascular Thrombectomy Corelates with Unexplained Neurological Deterioration and is a More Reliable Imaging Predictor of Prognosis in Anterior Large Vessel Occlusion Stroke;World Neurosurgery;2023-11

4. Comparison of clinical outcomes in patients with acute ischemic stroke who underwent endovascular treatment using different perfusion modalities: a real-world multicenter study;Frontiers in Neurology;2023-10-25

5. Mediator complex in neurological disease;Life Sciences;2023-09